• Eva E Tejerina, Chiara Robba, Laura Del Campo-Albendea, Paolo Pelosi, Alfonso Muriel, Oscar Peñuelas, Fernando Frutos-Vivar, Konstantinos Raymondos, Bin Du, Arnaud W Thille, Fernando Ríos, Marco González, Lorenzo Del-Sorbo, MarínMaria Del CarmenMDCInstituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Hospital Regional 1° de Octubre, Mexico Distrito Federal, Mexico., Valle PinheiroBrunoBPulmonary Research Laboratory, Federal University of Juiz de Fora, Juiz de Fora, Brazil., Marco Antonio Soares, Nicolas Nin, Salvatore M Maggiore, Andrew Bersten, Pravin Amin, Nahit Cakar, Young SuhGeeGCenter for Clinical Epidemiology of Samsung Medical Center, Seoul, South Korea., Fekri Abroug, Manuel Jibaja, Dimitros Matamis, Ali ZeggwaghAmineACentre Hospitalier Universitarie Ibn Sina Rabat, Mohammed V University de Rabat, Rabat, Morocco., Yuda Sutherasan, Antonio Anzueto, and Andrés Esteban.
• Intensive Care Unit, Hospital Universitario de Getafe, Carretera de Toledo, km 12.5, 28905, Getafe, Spain. evateje@gmail.com.
• Neurocrit Care. 2022 Dec 1; 37 (3): 649659649-659.

BackgroundDespite the need for specific weaning strategies in neurological patients, evidence is generally insufficient or lacking. We aimed to describe the evolution over time of weaning and extubation practices in patients with acute brain injury compared with patients who are mechanically ventilated (MV) due to other reasons.MethodsWe performed a secondary analysis of three prospective, observational, multicenter international studies conducted in 2004, 2010, and 2016 in adults who had need of invasive MV for more than 12 h. We collected data on baseline characteristics, variables related to management ventilator settings, and complications while patients were ventilated or until day 28.ResultsAmong the 20,929 patients enrolled, we included 12,618 (60%) who started the weaning from MV, of whom 1722 (14%) were patients with acute brain injury. In the acutely brain-injured cohort, 538 patients (31%) did not undergo planned extubation, defined as the need for a tracheostomy without an attempt of extubation, accidental extubation, and death. Among the 1184 planned extubated patients with acute brain injury, 202 required reintubation (17%). Patients with acute brain injury had a higher odds for unplanned extubation (odds ratio [OR] 1.35, confidence interval for 95% [CI 95%] 1.19-1.54; p < 0.001), a higher odds of failure after the first attempt of weaning (spontaneous breathing trial or gradual reduction of ventilatory support; OR 1.14 [CI 95% 1.01-1.30; p = 0.03]), and a higher odds for reintubation (OR 1.41 [CI 95% 1.20-1.66; p < 0.001]) than patients without brain injury. Patients with hemorrhagic stroke had the highest odds for unplanned extubation (OR 1.47 [CI 95% 1.22-1.77; p < 0.001]), of failed extubation after the first attempt of weaning (OR 1.28 [CI 95% 1.06-1.55; p = 0.009]), and for reintubation (OR 1.49 [CI 95% 1.17-1.88; p < 0.001]). In relation to weaning evolution over time in patients with acute brain injury, the risk for unplanned extubation showed a downward trend; the risk for reintubation was not associated to time; and there was a significant increase in the percentage of patients who underwent extubation after the first attempt of weaning from MV.ConclusionsPatients with acute brain injury, compared with patients without brain injury, present higher odds of undergoing unplanned extubated after weaning was started, lower odds of being extubated after the first attempt, and a higher risk of reintubation.© 2022. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.

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